The ruckus over the CRISPR gene-editing system hides a dark reality: its high cost may make it unaffordable and questions remain whether most insurance companies will pay for it.

The cost isnt coming down, said Mark Trusheim, director of the Massachusetts Institute of TechnologysNEW Drug Development Paradigms, a think tank working on the problem of how we will pay for expensive new drugs. Companies will say, We are developing these medicines, just pay us; insurers will say, We cant afford it.

Editas Medicineplans to use CRISPR-Cas9 to treat various diseases, including Leber congenital amaurosisBut in itsannual report, Editas noted significant uncertainty on whether payers would cover the treatment. In fact, a handful of insurance companieshave issued policy documents that exclude gene therapy from coverage, a move that experts say establishes policy against paying for CRISPR-based therapeutics.

Companies will charge whatever the market will bear, [said Tania Bubela, a law and policy expert]. Im not even sure that many of these gene therapies will work, and not all medicine is worth the price. But if these technologies become broadly used, especially in altering T cells for cancer, payers wont meet the demands of steep prices, and Bubela predicts that the system implodes under its own weight.

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CRISPR's high costs may limit development of gene therapy drugs - Genetic Literacy Project